Sherwin Nuland

Since the days of Hippocrates, the Father of Medicine, the principle that the physician must first of all be a good person has always been a basic assumption of all medical codes of behavior – meaning that he or she must be moral, beneficent, kind, and compassionate, in addition to being possessed of great skill. In this keynote speech, Dr. Sherwin Nuland traces the history of this principle as it has been understood and applied since its earliest days, and into the modern-day technological era.

As scientific medicine progressed from its beginnings in the 19th century, emphasis in medical training has increasingly been placed on the strictly technical aspects of diagnosis and treatment, and the role of the physician's empathy and compassion has gradually eroded, to the detriment of the patient's welfare. But until perhaps the 1960s, the goodness of the physician still continued to be taught and practiced. However, in the present high-tech age, its importance has become more and more neglected, with the result that the patient's personal values and needs, religious beliefs, life history, and family relationships assume a far lesser role in care than they have in the past, sometimes being ignored completely.

Dr. Nuland argues that this situation deters wise decision-making (particularly near the end of life) and interferes with the patient's psychological well-being. This deterioration of the doctor-patient relationship must be corrected if physicians are to do the best of which they are capable for every individual person who comes to them for healing. It is not too late to change the face of medical practice, to include the goodness of the personal with the finest of scientific medicine. After much thought and experience with such matters over the course of decades, Dr. Nuland present a solution that he believes will go far toward the desired result.

Dr. Nuland wrote The Art of Aging, in which he reports on the factors that are essential if the later decades of life are to be healthy, rewarding and useful. In this keynote speech based on that book, he tells of the changes that occur in various organs and functions of the body with the passage of years. He discusses physical, emotional and societal aspects as well as describing the steps that middle-aged or younger men and women should be taking in preparation for their sixties, seventies and beyond.

Dr. Nuland's book, How We Die, has been translated into 21 languages, was a finalist for the Pulitzer Prize and the Book Critics Circle Award, and won the National Book Award, America's greatest literary honor. In the book and in the keynote speech based on it, the author vividly describes the mechanisms of the most common causes of death (such, for example, as cancer, stroke and heart disease) and advises about the best ways to deal with them in order to provide dignity, compassion and honesty. He discusses the problems inherent in the health care system that stand in the way of a dignified death, and recommends solutions to them. The patient, the family and the physician all have a role to play in creating an atmosphere of emotional healing at the end of life, and these issues are explored frankly and with sensitivity.

For at least 1500 years, artists have been recording their impressions of doctors and medical themes such as disease, treatment and superstition. Sometimes their illustrations are meant to witness, sometimes to honor, and sometimes to ridicule. This presentation consists of a series of illustrations and running commentary on the development of the art of healing and its always vulnerable contributors, practitioners, quacks and patients. Some of the artists have names like Raphael, Rembrandt, Goya, Daumier, Eakins and Wyeth, while some are obscure or forgotten. Portraits, caricatures, dramatic scenes, illuminated manuscripts and cartoons are shown to illustrate various aspects of the talk.